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Preconditioning the human heart

A M Alkhulaifi1

  • 1Harefield Hospital, Middlesex.

Annals of the Royal College of Surgeons of England
|January 1, 1997
PubMed
Summary
This summary is machine-generated.

Ischaemic preconditioning, involving short bursts of reduced blood flow, may protect the human heart during coronary artery bypass grafting (CABG) surgery. This method showed reduced myocardial injury by preserving adenosine triphosphate (ATP) and lowering troponin T release.

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Ischemia-Reperfusion Biology

Background:

  • Ischaemic preconditioning is a known phenomenon that protects the myocardium from injury in animal models.
  • The potential for inducing ischaemic preconditioning in the human heart during cardiac surgery remained to be investigated.

Purpose of the Study:

  • To determine if ischaemic preconditioning can be safely induced in human patients undergoing coronary artery bypass grafting (CABG).
  • To assess the efficacy of ischaemic preconditioning in limiting myocardial injury during CABG surgery.

Main Methods:

  • Two randomized studies were conducted during CABG.
  • Study 1 measured myocardial adenosine triphosphate (ATP) levels from biopsies at different time points.
  • Study 2 measured serum troponin T release post-cardiopulmonary bypass (CPB).

Related Experiment Videos

  • Preconditioning involved two 3-minute cross-clamping periods with 2 minutes of reperfusion, followed by 10 minutes of sustained ischemia; control group received only sustained ischemia.

    • Main Results:

    • Preconditioned hearts showed a significantly slower rate of ATP depletion during sustained ischemia (11.5 vs 7.2 mumol/g dry weight; P < 0.005).
    • Troponin T release was significantly lower at 72 hours post-CPB in the preconditioned group (0.3 vs 1.4 milligrams; P < 0.05).
    • More patients in the preconditioned group had troponin T levels below 0.5 milligram at 72 hours (10 vs 3).

    Conclusions:

    • Ischaemic preconditioning can be induced in human patients undergoing CABG.
    • The findings suggest that ischaemic preconditioning reduces myocardial injury during CABG, evidenced by improved myocardial ATP levels and decreased troponin T release.